Planning for Medicare Part D: Tips for Choosing A Medicare Plan

Choosing the right Part D plan from the start

Updated on: December 7, 2020

Originally posted on: August 1, 2014
The Roadmap for Medicare staff specialize in all topics related to Medicare Part D, choosing a Medicare plan, and making smart health decisions in retirement.

For most Americans, Medicare eligibility begins at age 65. So if you’re nearing or at that age, now is the time to consider what your future healthcare needs will be. Medicare Parts A & B, and various Medicare supplement plans will help you cover your medical costs but, in most cases, they do not cover prescription medication. For that, you will need Medicare Part D. Even if you don’t take any medication now, that may change in the future. When you take prescription medications, you use your prescription drug benefit more often than any other health benefit. With the cost of some prescription medications, it does not take much for your pharmacy bill to grow significantly with just one prescription.

The Cheapest Part D Plan Isn’t Always the Best

Many of us make decisions based on our current health status – assuming our needs will remain unchanged over time. But when it comes to choosing a Medicare Part D plan, it’s vital to look ahead. Even though we’re living longer, on average, boomers have health issues that are unique to their generation. In fact, approximately 80% of older adults have at least one chronic disease, and 77% of this age group have at least two conditions to manage. Diabetes is one of many chronic diseases that become more prevalent with age. Boomers also face a 90% lifetime risk of developing hypertension (high blood pressure).

Given these odds, it’s important to enroll in a prescription drug plan now that will provide the coverage you need in the years ahead. Research shows that few seniors switch plans after enrolling in their initial plan. Unfortunately, when their health status changes, they’re left with coverage that falls short.

Consider These Four Medicare “Rules of the Road”:

  1. Premiums: This is the monthly fee for your Medicare Part D plan. Don’t choose a plan based only on a monthly premium. Low-premium plans often have higher prescription copayments and could end up being more expensive when all costs are considered.
  2. Formulary: A formulary is a list of the medications covered by the plan. Choosing a plan with a well-built formulary can save you time and money, offering affordable options that meet your medication needs today and in the future.
  3. Pharmacy access: Plans that provide a “preferred pharmacy network” offer more savings when you use a local pharmacy that participates in their network. Plans offering a home delivery pharmacy may provide additional savings and convenience.
  4. Pharmacists: Consider a plan that offers round-the-clock access to pharmacists. They can answer questions by phone, help prevent harmful drug interactions, and recommend lower-cost, safer medications — all from the privacy of your home. Some plans even provide specialty-trained pharmacists who have an expertise in and focus on the medications that treat chronic diseases like diabetes, and can offer you greater support in managing that condition.

Remember, it’s not a question of “if my needs change,” but “when my needs change.” Select the plan that’s right for you for the long haul — right from the start. Unless you have prescription drug coverage provided to you by your employer, you should consider enrolling in a Part D plan when you reach age 65. For most Medicare beneficiaries, the Annual Enrollment Period begins on October 15 and ends on December 7 each year. If you delay enrolling, you can face a Medicare penalty, which will remain in effect as long as you have Part D coverage. So while you may save money in the short term by delaying enrollment, you may unnecessarily add to your overall costs.

If you turn 65 this year, you have a 7-month period in which to enroll: up to 3 months before your birth month, your birth month, and up to 3 months after your birth month. Medicare also provides a Special Enrollment Period for beneficiaries under certain circumstances, such as those who move to a different state or lose employer coverage.